Anesthesiologists drive up cost of GI procedures

NEW YORK (Reuters Health) - More and more patients are being monitored by an anesthesiologist during endoscopies and colonoscopies, suggests a new study, adding a billion dollars in costs.

Researchers found that using an anesthesiologist or nurse anesthetist for endoscopies and colonoscopies added hundreds of dollars to the cost of a procedure -- and the number of patients who went that route more than doubled between 2003 and 2009.

“If we keep going in this direction, we can’t afford it,” said Dr. Lee Fleisher, an anesthesiology and critical care doctor from the University of Pennsylvania in Philadelphia, who wrote a commentary on the new study.

Under fee-for-service health care, doctors who perform gastrointestinal, or GI, procedures are reimbursed from insurance companies or Medicare at the same rate whether or not they give patients sedatives and painkillers themselves. If an anesthesiologist or nurse anesthetist is involved to give sedation, however, they’ll charge whoever’s paying for the procedure an extra fee.

But even with a designated person giving anesthesia, patients aren’t necessarily getting more serious sedation -- just another body in the room, one of the researchers on the new study said.

“You get sedation in both cases, you just get sedation for an extra $500, and there may not be any difference in the sedation you get,” said Dr. Soeren Mattke, from the RAND Corporation in Boston.

“You add a lot of cost, with no proven safety or patient experience benefit,” Mattke said.

LACK OF EVIDENCE

For the current study, Mattke and his colleagues tracked a sample of 1.1 million Medicare patients and another 5.5 million with private insurance who had endoscopies and colonoscopies between 2003 and 2009 -- a total of more than nine million procedures.

Based on claims, the researchers calculated that insurance providers were billed for anesthesiologists on about 14 percent of GI procedures in 2003.

By 2009, 30 percent of procedures for Medicare patients and 36 percent for privately-insured patients involved an anesthesiologist or nurse anesthetist.

That added about $150 to the bill for each procedure when Medicare was paying, and $500 for patients with private insurance, according to findings published Tuesday in the Journal of the American Medical Association.

All of those patients were low-risk, without heart or breathing conditions, meaning there was no medical reason they would need an anesthesiologist monitoring their sedation. And Mattke said that although they might get a different type of drug depending on who is doing the sedating, there’s been no evidence showing that those patients do better when an anesthesiologist is involved.

Fleisher said for patients who really want deeper sedation from an anesthesiologist, that’s still a valid option for them.

He especially doesn’t want patients being scared away from getting colonoscopies for cancer screening because they’re afraid of not getting enough anesthesia.

Guidelines from the United States Preventive Services Task Force, a government-backed agency, call for regular colon cancer screening in people age 50 to 75, every ten years if they choose to screen with colonoscopy. One recent study found evidence that the procedure, during which precancerous polyps are removed, can halve a person’s risk of dying from colon cancer (see Reuters Health story of February 23, 2012.)

Fleisher told Reuters Health that using an anesthesiologist during a GI procedure shouldn’t automatically mean more reimbursement from insurance companies or Medicare, with no extra cost or responsibility for patients or doctors.

“There’s probably some way... to make it a more rational, financial decision whereby for the appropriate patients it’s utilized and ones in which it’s not necessary it’s not utilized.”

Mattke said that in a time when cutting health care spending is especially important, policy makers and doctors themselves have to be on the lookout for chances to get rid of any “low-value services,” including those that add costs without clear benefit.

And patients can be involved too, he said, by knowing their different options and the medical evidence behind them.

SOURCE: Journal of the American Medical Association, online March 20, 2012.